In some cases, an individual may be entitled to receive insurance benefits based at least in part on past wages that he or she has earned. For example, an injured worker might receive workers' compensation payments from an insurance company based on his or her average weekly wages over the prior year. To submit information about past wages to an insurance company, an injured worker or an employer representative, such as an employee in a human relations department of an employer, might provide copies of old paychecks, screenshots taken from a payroll accounting system, and/or information manually entered by hand on an insurance form. A claim handler associated with the insurance company might then review the wage information and determine an appropriate benefit amount. Such a determination, however, can be difficult to perform in an accurate and consistent manner. For example, extended periods away from work, bonuses, and overtime pay may need to be accounted for by the claim handler. Moreover, the appropriate way to handle these situations varies depending on the jurisdiction in which an injury occurred.
Individual jurisdictions have generated required paper forms on which information regarding the injured worker, including past wage information, must be submitted. The forms vary among jurisdictions as to format and required information.
In addition to average weekly wage information, individual state forms may require display of such information as gross earnings and other earnings. Calculations of these values may vary among jurisdictions, depending, for example, on rules governing rates for overtime and double time. These values are in turn employed in calculation of average weekly wage values. Errors in these values may result in rejection of filings of required forms.
As a result of variations in rules from jurisdiction to jurisdiction, required information and underlying formulas need to vary from jurisdiction to jurisdiction. Individual claim handlers and employer human resource departments may be responsible for injured workers in multiple jurisdictions. It would be desirable for capabilities for calculations and generation of suitable forms in multiple jurisdictions to be available without a need for separate application programs or for large programs that require extensive storage, transmission and memory resources.
A wide variety of options may be available for determination of pay periods. For example, different employers may use weekly, bi-weekly, monthly, semi-monthly and other pay periods. Accurate determinations of past pay period begin and end dates may be difficult as a result.
Note that penalties may be applied to an insurance company that fails to determine benefits in an accurate and consistent manner. For example, a state auditor might assess penalties, including interest penalties, when an insurance company fails to determine and/or document workers' compensation cases in an appropriate manner. Moreover, note that problems might arise from inconsistent and/or inaccurate wage statement data provided by an injured worker or an employer, inconsistent and/or inaccurate benefit calculations by a claim handler, or insufficient documentation about the benefit calculations in a claim file.
Systems and methods for improvements in processes relating to processing of workers compensation claims, including greater accuracy in determinations, while avoiding unnecessary burdens on computer processing resources, would be desirable.